The following considerations apply in the early management of a patient with an electrical injury:
- Cardiac Monitoring
- Aggressive Management of Myoglobinuria
- Additional Fluid Resuscitation
- Management of Compartment Syndrome
Electrical injuries may result in a variety of cardiac arrhythmias, including asystole and ventricular fibrillation which manifest very soon after injury.
CPR should be initiated for those in cardiac arrest
Aggressive Management of Myoglobinuria
Muscle damage can result in myoglobinuria and haemoglobinuria. These pigments can exacerbate acute renal failure. Prompt diuresis will help to protect against pigment deposition in the renal tubules and kidney damage.
If pigment is evident in the urine, intravenous fluids should be increased to create a urine output of 75 – 100 mls/hr to ‘flush’ the kidneys. Diuretics may be required as an adjunct.
Additional Fluid Resuscitation
Fluid resuscitation requirements in an electrical burn are usually more than that indicated by the extent of the cutaneous burn. Muscle damage that is not immediately evident can cause fluid loss which is not accounted for by the standard Parkland formula. It is important to always titrate fluid resuscitation according to urine output goals.
Patients with high voltage electrical injuries are at risk of developing compartment syndrome. Damaged muscle swells and the high pressure within the investing fascia can obliterate blood flow and result in further muscle necrosis.
- Elevate affected areas to help to minimise swelling
Signs of compartment syndrome:
- ‘tight’ muscle compartments in limbs
- pain at rest
- increased pain on passive extension of digits
- decreased distal sensation
- decreased distal perfusion
If multi-compartment fasciotomy is required, consult with Adult Retrieval Victoria and the appropriate Burn Service before proceeding